Friday, March 22, 2013

Borderline Personality Disorder versus Bipolar Disorder: Differences Part 2


On and on we push we will! There are yet still more seemingly similar problems that Borderline Personality Disorder shares with Bipolar Disorder.

  
#6 Difference and Similarity – Destructive Behavior and Self-harm

Borderline – I’ve written a ridiculous amount on self-destructive behavior with BPD. What it’s not, is an attempt to kill ourselves. This is something that it typically shares in common with Bipolar. For Borderline it’s a way to feel connected, a way to feel, a way to establish a connection to the world, a way to stop the pain or re-direct the emotional pain into a physical pain that we can control, or even a way to punish ourselves for something that we feel we did wrong. Then of course individuals may have their own reasons. This is the very short abbreviated version.

Bipolar – From what I gather with Bipolar self-destructive behavior and self-injuring behavior occur when individuals experience feelings of invincibility and being all powerful. They engage in behavior so dangerous or so extreme because they don’t recognize the extent of the damage that can be done to them. Perhaps this is during a manic phase? I feel like there needs to be a distinction made between destructive behavior engaged in during mania, depression, and mixed episodes. During depressive episodes I know for a fact that the reasons for destructive behavior and self-harming behavior can be for exactly the same reasons as the ones expressed by those with BPD.  And when some with Bipolar is having a mixed episode they may be so depressed, yet so impulsive due to their mania that they act rashly and destructively in a way that is more personally destructive than they would have normally meant to.


#7 Difference – Impulsive Behavior

Bipolar – Impulsive behavior can occur for lengths of time spanning the length of entire manic episodes.

Borderline – Impulsive behavior occurs spontaneously and erratically.

I actually think Impulsive Behavior can be more dangerous for people with Bipolar, especially during times of mania. Why do you ask? Because when I get impulsive, I act on it, and then it’s usually done, or at least by the next day I’m usually done. When you’re bipolar and manic and impulsive… those behaviors becomes SPREES of impulsivity. Remember Friend? His wife bankrupted them, literally, because she was such an impulsive spender when she was manic. Maybe this happens with Borderline too, but not my particular brand of Borderline.

Maybe ‘more dangerous’ is the wrong word, but longer impacting depending on the type of impulse. Obviously if your impulse is reckless driving, then it only takes getting it wrong once to get it wrong forever fatally… but if you have long term spans of manic impulsivity your risk factor is exceedingly higher than if you are just occasionally impulsive.

Bah, who am I kidding. They’re neither is any good.


#8 Difference - Relationship Basis

Bipolar – The trouble that people with Bipolar Disorder experience tends to be less relationship-based. People who suffer from Bipolar Disorder often display cycles of mood which are more inwardly self-focused and have less to do with how they feel about the relationships they are involved in. While Bipolar Disorder certainly effects a person’s relationships, a person’s relationships usually aren’t what directly effects a person’s disorder.  

Borderline – Well we know the exact opposite to be true. While there is some inborn biogenetic temperament for BPD, environmental effects and our relationships are what effect and shape our maladaptive personality traits and turn them into disorders. BPD is often described as a disorder of relationships and the nature of our relationships can be the thing the directly triggers our disorder.


#9 Difference -  Dissociation

Borderline - Borderline Personality Disorder comprises both psychotic & neurotic thought processes. This gives rise to the name "Borderline" because it is thought to be on the "borderline" between psychosis & neurosis. The thinking and behavior of a person with Borderline Personality Disorder includes more mental departures from reality, known as Dissociation or "feelings create facts".

Bipolar - In contrast, Bipolar Disorder tends to be more neurotic in that the mood swings tend to be based more on extreme exaggerations of fact.





There is one thing that Bipolar and BPD do share in common though. There is still a lot of stigma and misinformation floating around out there. I can’t give a full account of Bipolar because I don’t suffer with it, but hopefully I’m not providing any false information.

Darkness dragging on


Sorry Everyone.


I’m having a terrible time at the moment. I’ve reached a point where I honestly can’t tell if my unhappiness is just me or if the world around me simply sucks that bad. It’s probably an unhealthy mix of both.


Empty, thoughts of cutting, not necessarily thoughts of suicide but, not being able to see my future or see the point of bothering with having a future. The weight of it all just seems like so much sometimes. With so very little to look forward too. The moments of light and laughter come and go so quickly it’s like they were never there at all. Fortunately I’ve lived with these times so often for so long, that I know they’ll pass. The moments drag and it can be so hard to remember there can be an end to them, but I do know now that there is an end.  This won’t last forever.


I prefer the anger and destruction to the darkness and depression. Any day that’s what I prefer.


I’ve been on this new medication for a week. It’s a very low dose so I’m not sure if it isn’t working at all yet, or working adversely. 


Anyways. I’m trying to get my posts out but I have so little energy and so little motivation what little I have I need to prioritize into the stuff necessary for my life to function. If posts come out a little slower than usual, don’t fret too much, they’ll still come. 

Thursday, March 21, 2013

Borderline Personality Disorder versus Bipolar Disorder: Differences


So I think it’s pretty easy to see how Borderline Personality Disorder and Bipolar disorder can look similar on the surface. Once you look a little deeper though those similarities start to look a lot less alike though. I’ve been debating how to handle the differences. Since I just did the similarities should I now look at those and show how they’re not actually so similar? And then talk about the real heart main differences that we don’t share in common? But I think it’s more important to understand that these two disorders are really two very different things. So I’ll debate the details later. Let’s cut to the chase and get to the heart of the matter now.



Here’s the thing. While both BPD and Bipolar revolve around the expression of fluctuating moods, Bipolar Disorder is a neurological disorder. It’s hardwired. Environmental factors do absolutely influence the initiation and expression of bipolar disorder and bipolar episodes, but not in the same ways that they do with Borderline PD. With BPD our environment or something relating to it, and the people within our environment (if not ourselves) are what trigger us nearly 100% of the time. It can happen randomly and at any given moment depending on the stimuli we face. With Bipolar manic-depressive cycles are not random though that doesn’t mean they’re predictable. With Bipolar there does tend to be a cycle or pattern to the periods of mania and depression that are experienced (unless a person experiences rapid-cycling phases, then it’s a little more difficult to distinguish and more dependent on stress response). This is dependent on the person’s particular brain chemistry. If left untreated, these cycles can increase in frequency over time. How a person reacts during these periods though, can be unpredictable depending on what goes on.  

There are many theories and a lot of research into the neurobiology involved in Bipolar Disorder.

“The neurobiology of bipolar disorder is associated with alterations in central nervous system function from the level of large-scale brain circuits to intracellular signal transduction mechanisms. Because of the broad spectrum over which these abnormalities appear, the causative effects are most likely present in the lowest common denominator of all of these systems. Functional imaging (fMRI) focus on large-scale changes in both cerebral blood flow and metabolism. These studies showed that bipolar-depressed patients had significantly lower cortical metabolism than either controls or patients with unipolar depression. Both mania and depression are characterized by profound global changes in brain function. These state changes are manifest at multiple levels in the nervous system. There are also alterations in brain chemistry and neurochemical changes present in people with bipolar disorder. These neurochemical changes are evident in virtually all levels of the central nervous system.” [1]

The list of neurobiological systems affected doesn’t stop here either. But as you can see the cause of this disorder is easily identified as being obviously biological in natural.

As opposed to BPD which does have some biological roots, but is equally influenced by environmental factors as well. Also, as I’ve talked about previously in articles discussing the neurobiology of Borderline Personality Disorder, the affected areas of our neurochemistry occur in entirely different locations.

The term ‘bipolar’ can also be a little misleading because it indicates that individuals are always either manic or depressed and that these states are at opposite ends of a spectrum. The reality is much more complex though. While the manic and depressed states do go well beyond the normal functioning ranges for most people they span a range of intensity and can even be mixed and felt at the same time. Not only that, but between times of mania and depression it’s not uncommon to have periods of ‘normality’ when a person with BD is neither manic nor depressed.

As opposed to someone with BPD, we’re just sort of always the way we are… which is to say, kind of unpredictable (without treatment!) and always up, down, in between, mixed up, angry, okay, happy, sad, well, you get the picture.

My point is the:

#1 Main Difference between BPD and Bipolar is Neurological Brain Chemistry. Bipolar is a brain disorder where BPD is an emotional disorder.

Bipolar - is an Axis-1 Mood Disorder

Borderline Personality - is an Axis-2 Personality Disorder

Simple. As. That. Doesn’t matter how it looks. Doesn’t matter how it appears on the surface. What matters is what’s actually going on inside our heads. And that’s a whole different mix of chemical-emotional combinations.

They both suck. 
Don’t get me wrong, every single person in existence (with the exception of people that have no empathic or emotional affect) are effected by their environment. But the extreme shifts in mood that Bipolar experience are due to/enhanced by chemistry. The moods in people with BPD are more dependent, either positively or negatively, on what's going on in their life at the moment and our maladaptive emotional/behavioral responses. Anything that might smack of abandonment (real or perceived  is a major trigger, etc.

That’s not to say that one or the other is better or worse to have. They both suck huge monkey balls. For those who have them, and for the loved ones that get to live with those of us that have them, but they are different things. This is an important distinction to make because it defines the #2 difference.


#2 Difference Between BPD and Bipolar Disorder: Treatment

Bipolar – The first course of treatment for Bipolar is typically a mix of medication. The second course of treatment, if it’s chosen at all, is cognitive therapy. There are many, many medication types and classes used, tested, and proven useful in the treatment of Bipolar Disorder. This doesn’t actually mean it’s easy to find the proper combination of medication for a person, and medication often has to be adjusted depending on the time of year, but as it is a disorder of chemistry, it is more likely to be chemically treated. It’s also widely accepted that once a good medication regime is found a positive response is very likely to be achieved.

BPD – The first course of treatment for BPD is cognitive therapy (DBT, CBT, etc). The second course of treatment, if chosen at all, is medication. If medication is pursued, it’s never chosen to treat BPD as a whole because there is no medication that treats BPD as a whole. Medication is chosen to treat specific symptoms of BPD. The most important thing is to learn how to cope with our maladaptive behavioral coping mechanisms and replace them with constructive adaptive ways of coping. The course of medication and therapy is likely to take months, even years longer achieve similar healthy results.

Both groups are often reluctant to seek help and may be resistant to medication. Also, both groups have a tendency to stop taking prescribed medications when they begin to feel better which often leads to relapses.


#3 Difference Between BPD and Bipolar Disorder: Cycling

Bipolar – People with Bipolar disorder cycle in periods for extended periods of time. Even with rapid-cycling bipolar these periods can last for days.

BPD – People with BPD cycle through moods much, much more quickly; often several times a day. Hell, often several times an hour.


#4 Difference Between BPD and Bipolar Disorder: Mood Swings

Bipolar - People with bipolar disorder swing between all-encompassing periods of mania and major depression.

BPD – As Marsh M. Linehan says, in people with BPD, the mood swings are more distinct. The mood swings typical in BPD are specific to the particular situation. She says, "You have fear going up and down, sadness going up and down, anger up and down, disgust up and down, and love up and down."

Now! That doesn’t mean a manic phase encompassing a very irritable, angry person with Bipolar Disorder is going to look much different than the nasty, bickering bitchiness of pissed off Borderline, however maybe something about April is the time of year when some with Bipolar Disorder starts to get manic, whereas with BPD, you might have just triggered an insecurity or done something we took offense too that spun our emotions out of control. They can look the same, but the causes are different.


#5 Difference Between BPD and Bipolar Disorder: Depression

Bipolar – Depression is a guarantee. It’s one half of what puts the ‘bi’ in bipolar. It occurs cyclically after a period of mania or euthymia (normal mood) and can often be the “normal” mood.  

BPD – Depression is not a guarantee. While it is very common that someone with BPD will also suffer from depression at some point, and nearly 50% of us with BPD have co-morbid Major Depressive Disorder, it is not necessarily a part of the package. If it is a part of the package, it is not necessarily cyclic. Depression can be triggered for any number of reasons, or be your baseline level of mood existence. Or if you happen to be like me, you exist in depression and get even more depressed at a particular point during the year. So it’s like the worst of both worlds all wrapped up together ::head desk::.


… That’s enough for today. There’s more though! Tomorrow I’ll debunk some of those “similarities”. 

Tuesday, March 19, 2013

Borderline Personality Disorder versus Bipolar Disorder: Similarities


Now that we’ve discussed exactly what Bipolar disorder is, why is it so often confused with Borderline Personality Disorder? Or vice versa?


The answer is simple. At least it’s simple to me because I immerse myself in this research everyday. To the everyday, average person, it can be pretty confusing. Because on the surface when all you have is a check list of features and symptoms on the surface the two disorders appear rather similar. One the surface. Let me reiterate something. This is why it is crucial to be diagnosed by a trained professional and not assumed via self-diagnosis.

Think about the things that you usually notice about a person that you suspect has Borderline Personality Disorder. Their moods can be all over the place. Depending on when you see them they can seem like one person or someone else entirely. They may be depressed or seem fine or even quite happy. They might be the life of the party to the point of recklessness, driving fast, talking faster, partying hard. You might notice the signs of self-harm or foolish spending.  You may even think they just have a drinking problem at times by how much they indulge. The stuff people typically see. This is also the stuff that clinicians typically find out right away upon first meeting a new client. The problem though, is that when that’s all you now at first, the description can be misleading.  

Similarities

Both bipolar disorder and BPD can interfere with relationships, work, and/or school, and the ability to lead a productive life. They both may encompass:

  • Disorder of extreme mood fluctuation and instability. — Bipolar disorder causes extreme shifts in mood from depression to mania (a mood characterized by abnormal elation and energy, racing thoughts and speech, a decreased need for sleep, etc.). BPD is also associated with mood changes, causing people to frequently switch between feeling fine to feeling extremely distressed in a matter of minutes.


  • Depression – Both BPD and Bipolar Disorder may experience depression at times. With Bipolar it is part of the clinical diagnosis that this will occur while with BPD it is only a potential co-morbid mood characteristic.


  • Self-destructive behavior – This can range from self-harm to suicidal thoughts or actions


  • Impulsive Behavior - Both bipolar disorder and BPD cause people to act impulsively. These impulsive behaviors can include rash spending sprees, reckless driving, foolish financial investments, risky sexual behaviors (promiscuity), binge eating, substance abuse and self-injury.


  • Hypersexuality – As with BPD people diagnosed with Bipolar disorder can be preoccupied with sex and sexual activity. I’m making a difference between promiscuity and hypersexuality here because while being promiscuous can be reckless and impulsive, hypersexuality is more indicative of a preoccupation with sex and can just involve a single partner.
    • It should also be noted that impulsive sexual behavior and hypersexual behavior are not required for either disorder. I know people with both BPD and Bipolar that aren’t interested in sex at all, or at least not more than normal.


  • Potential for Drug and Alcohol Abuse — It’s not uncommon for people with untreated bipolar disorder or BPD to abuse alcohol or drugs as a way to cope with their symptoms. Unfortunately, substance abuse only aggravates symptoms and can hinder or hide a true bipolar or BPD diagnosis.


  • Delusional thinking/Paranoia - A delusion is a belief held with strong conviction despite superior evidence to the contrary. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy concerning a perceived threat towards oneself.  Making false accusations and the general distrust of others also frequently accompany paranoia. For example, an incident most people would view as an accident or coincidence, a paranoid person might believe was intentionally done to hurt them.



 
Now I shall dash this all to pieces. While we do share all of these things in common, the underlying motivations can be very, very different. Some are the same or similar, though many only look that way. The checklist symptom is the only real commonality. The impetus for them is vastly different. And why you absolutely cannot simply look at a list of symptoms and jump to your own conclusions about something so complex as mental health issues.  Tomorrow we’ll explore just how different these two disorders truly are.



** I’m having trouble getting information that I have found. There is a lot of information out there but only at a very high monetary cost. Very high. I’m doing the best I can with the resources I can find though. 
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